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Before leaving for the er:

BEFORE LEAVING FOR THE EMERGENCY ROOM
Accidents and emergencies happen with kids – usually at night or on a weekend. The Children’s Clinic of
Richardson is committed to reducing emergency room visits for members of our medical home. First, call
the nurse line
associated with your insurance plan.
If your child has a fever, do not panic. Fever is just the body’s way of fighting off infection. Babies under 3
months of age need to be seen if their under-the-arm or axial temperature is 100.4F (38.0C) or more. Do
not give Tylenol to a baby under 3 months old or Motrin to a baby under 6 months old. Call the clinic
during regular business hours, or call a nurse line if possible, or just seek help at the closest ER.

For all children over the age of 3 months, FEVER is a temperature of 101.0F (38.3C) or more. Do not give
Tylenol or Motrin until your child’s temperature reaches 101.0F (38.3C). You need to be able to tell us how
long your child has had a FEVER. Take your child’s temperature under the arm or under the tongue. Ear
thermometers are not very accurate. Tylenol or Motrin will not help a cough, wheeze, runny nose or
rash
.
Do not give both Tylenol and Motrin – pick one.
Tylenol Dosing Chart (For children over 10 years, follow instructions on box.) Motrin Dosing Chart (Do not give Motrin to a child less than 6 months of age.) VOMITING
Babies under 3 months of age with forceful vomiting need to be evaluated quickly – go to the ER. Older
babies and children may be offered Pedialyte (not Gatorade) to rest their tummies. Offer Pedialyte for only
6 hours
. Then, restart a regular diet slowly. The juice of a can of fruit cocktail with heavy syrup can also be
given during this 6-hour period. It soothes the stomach and helps with nausea. If you have a question
about your child’s vomiting, call a nurse line.

ABDOMINAL PAIN
If your child is in so much pain that he cannot walk or jump up and down – go to an emergency room.
HOWEVER, most cases of abdominal pain are not emergencies. If your child has constipation, this is not an
emergency. Call the nurse line for advice. If your child has abdominal pain and a fever of 101.0F (38.3C),
call the nurse line for advice.
If your child has ear pain, give Motrin and use warm compresses to relieve the pain. Do not give Motrin to a
child younger than 6 months. If the pain can be controlled, ear pain is not an emergency. Call early in the
day for an appointment. If your child has ear tubes, and you see drainage coming out of the ear, this is not
an emergency. This means the tubes are working. Keep the ear canal clean and DRY, and call the clinic.
Usually, drainage from ear tubes does not require an appointment and can be handled over the phone.
POISONING
If your child swallows a cleaning agent, adult’s medication, or other poison, call 800-222-1222. Take
the substance you think your child swallowed to the emergency room.

DIARRHEA
Loose stools happen for many reasons. The most common reason your child may have loose stools is that
he has a virus. Another reason is he drinks too much juice. While having diarrhea, stop all juice intake.
Remember, what goes in comes out. So, if you give a child only Pedialyte, then his stools will be watery,
like Pedialyte. Babies with diarrhea need to be evaluated – call for an appointment. Children with bloody
stools
need to be evaluated – call for an appointment. Children who look dehydrated (dry lips or mouth,
decreased urination, sad-looking) with loose stools need to be evaluated – call for an appointment or go to
an ER after regular business hours. Older children, with no fever, and no vomiting, just loose stools need to
eat foods that will bulk up their stools. Feed them bananas, oatmeal, yogurt, cheese, pasta, and bread.
If a diaper rash or skin irritation develops while your child has diarrhea, follow these steps: Stop using baby wipes – clean the area with plain soap and water Open the diaper up to air as much as possible Apply Desitin or Vaseline after each diaper change If you have a question about your child’s diaper rash, call a nurse line.
In our medical home, all children with asthma are given an asthma action plan to follow. If your child is
having an asthma episode, give a breathing treatment and call a nurse line. Have the following
information ready to give to the triage nurse:

 Tell the nurse how many times your child takes a breath in one minute Tell the nurse how long it has been since you gave your child a breathing treatment or a dose from  Tell the nurse if your child has ever been hospitalized for asthma Tell the nurse if your child is a premature infant If possible, have your child do a peak flow and tell the nurse if he is in his red or yellow zone. If in red zone, give 3 treatments as directed on the action plan If the triage nurse tells you to go to an emergency room, take all of your child’s medications and take your
child’s action plan. After the ER visit, call the clinic for follow up.
Rashes are rarely an emergency. If your child is over 6 months old and has a rash that is puffy, itchy and
red (hives), try giving your child a dose of Benadryl.
Benadryl Dosing Chart (Do not give Benadryl to a child less than 6 months of age.)
For children over 47 pounds (21.4 kg), consult the directions on the Benadryl package. If you have a
question about your child’s rash or allergic reaction, call a nurse line.

SORE THROAT
Most mild sore throats are viral and do not need antibiotics; but it severe, we need to do a test for Strep
throat. Give your child Tylenol or Motrin for fever over 101F, if needed. Make him more comfortable with
popsicles or cold liquids or hard candies, if old enough. Older children can gargle with warm salt water
(½ tsp salt in 8 oz of warm water). Listerine mouth wash is a good germ killer for the throat. CHANGE
YOUR CHILD’S TOOTHBRUSH AFTER EVERY THROAT INFECTION! If you have a question about
your child’s sore throat call a nurse line.

POISONING
If your child swallows a cleaning agent, adult’s medication, or other poison, call 800-222-1222. Take
the substance you think your child swallowed to the emergency room.

All information listed here are suggestions to reduce needless emergency room visits only.
If your child has an emergency, call 911 or visit the emergency room closest to your home.
Martha Strong, RN, CPNP ● Children’s Clinic of Richardson ● 972-664-1616 ● www.childrensclinic.us

Source: http://e0c86eb451055c8632c2-de41cff3678e8ee39fc884da07c2ad6f.r75.cf2.rackcdn.com/b678b3ceae1349ba82222c65e5431180.pdf

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